Protocol dilemma

June 24, 2011

Protocol for safety services including EMS and law enforcement is changing constantly to deal with bath salts.

In a flash, Wapakoneta EMS personnel watch as a person being transported in a rescue squad jumps out the back door when the vehicle stops for a traffic light at the intersection of Wood and Bellefontaine streets. He flees the scene on foot.
While the Wapakoneta police K-9 tracks the suspect back to his home, the suspect cannot be found.
His wife worries because her husband has been acting strange for approximately six weeks. His co-workers say he has been bragging about using âbath salts,â a synthetic psychoactive drug with stimulant properties that have been likened to ecstasy as well as a synthetic stimulant with amphetamine-like or cocaine-like effects. These âbath saltsâ are not like Calgon or Epsom salts.
Sammy OâQuinn Jr., 31, the man who jumped from the rescue squad, is located later that same day in early May. This time a police officer elects to ride in the back of the rescue squad to the hospital to protect EMS personnel and OâQuinn.
The incident resulted in a change of protocol for EMS personnel and Wapakoneta police officers. Today, if a person is suspected of using bath salts, law enforcement officers are asked to respond in conjunction with EMS, Wapakoneta Police Chief Russ Hunlock said.
This is adding cost to EMS runs and causing more emotional and physical stress for those responding to an emergency.
Reflecting on the past few months, Wapakoneta Fire Chief Kendall Krites said he knows the âbath saltsâ epidemic is causing increased costs for EMS service.
âThese scenes are like lightning in a bottle,â Krites said. âThere is a lot of time and there are a lot of resources wrapped up with this person who is not of clear mind. We are seeing an increase in our services being used up by these individuals, so we are not as readily available for medical emergencies â people injured in a traffic mishap, a response to a home, or whatever.â
Auglaize County Sheriff Al Solomon said other EMS units and law enforcement personnel throughout the county are using the same protocol â if law enforcement officers or EMS personnel suspect a person is on bath salts then both respond.
âIf there are any adverse conditions, if that person shows any affects of this, you almost have to have a rescue squad vehicle and EMS personnel there because if you donât and there are any problems it could be too late,â Solomon said, referring to the drug heightening physical ailments.
Krites explained âbath saltsâ causes a personâs heart rate and blood pressure to elevate and it depletes the amount of oxygen in their blood. He also said the drug also can cause renal failure, acute myocardial infractions (heart attacks) and strokes in the more extreme cases â resulting in death. There have been at least four deaths in the country and one in Ohio blamed on the use of bath salts.
A troubling side effect, Krites noted, is people often develop a craving for the drug that prompts them to go on days-long binges. They said users tend to please their craving every 24 hours. The immediate effects can last 72 hours and even longer, while the long-term effects are unknown, but flashbacks are common.
These bath salts, engineered by a chemist in a lab, contain the active ingredients methylenedioxpyrovalerone (MDPV), a synthetic psychoactive drug with stimulant properties that have been likened to ectsasy. Mephedrone is a synthetic stimulant with amphetamine-like or cocaine-like effects.
Common street names include âIvory Wave,â âBliss,â âWhite Lightningâ and âVanilla Sky.â Some describe the effects like cocaine, others like LSD.
Through their experiences, local safety service personnel have witnessed people on bath salts having hallucinations, mood changes in seconds or minutes, and paranoia, especially of law enforcement.
They have heard the users talk about seeing and talking with the devil, seen them worship animals, others see and talk to ghosts. Officers have seen users have conversations with people who are not even there.
A recent case at the Mercer County Fairgrounds, Celina police officers found a person on bath salts who was walking around barefoot and talking on his shoe as if it were a cell phone.
The downside after taking bath salts is the severe depression when the user finally comes down, Krites said.
Hunlock and Solomon said they try to get people help at St. Ritaâs Medical Center in Lima, or arrange for help at places in Columbus, Dayton or Toledo.
With the drug being so new, medical and forensic research is still catching up.
âWe are getting information, but it is through directives and articles,â Solomon said. âSome people think it is like crack cocaine, but I think people react to it more like it is LSD.
âThey are trying to put together some training on it,â he said, âand we are trying to put together some protocol but it is just so new.â
The problem with developing an effective protocol spreads to Childrenâs Services.
âWe have heard it is so new and the reactions so diverse that they canât give you an effective protocol for caseworkers to follow,â Auglaize County Childrenâs Services Director Pat Knippen said. âSince this drug is so new, we donât know how long before we can return kids safely into their home â so we are always going to error on the side of safety.â
There was one case where there was nothing medically wrong with a mother who had children except she was delusional. The hospital could not keep her but they wanted Children Services caseworkers to know. The woman, who did not come down from the high for several more days, stayed with her parents while the children stayed with a relative.
âWe have a problem right now where 15 total children are not with their respective parents because we donât even know when it is safe to send them back,â Knippen said.
One is in foster care, with the county paying for the childrenâs stay, while nine are with relatives. One parent lost custody of their child to the non-custodial parent because the custodial parent used âbath salts.â
âFor our purposes, if you are using salts then they (children) probably wonât be with you for awhile and I donât know how long âawhileâ is because nobody knows what the lasting effects of the salts are and how dangerous they are,â Knippen said.
Hunlock, Krites and Solomon agree people will likely need a hospitalâs drug and alcohol component combined with the mental component.
Dr. William Tucker, who works at St. Ritaâs Medical Center, said the protocol for a person admitted to the hospital on bath salts is the same as any other patient â they are evaluated, a medical screening is done and if there is a medical emergency then hospital personnel determine how to best take care of them.
âPeople on bath salts are coming in with various stages of symptoms, problems with their heart and breathing so we treat their physical ailment,â Tucker said. âThere are those with psychiatric illnesses and we try to control them with anti-psychiotics and anti-anxiety medications â the extent of their illness varies from patient to patient.â
Tucker seconded the law enforcement findings, the psychological effects of a person on bath salts can last quite a while and âthere is no clear cut cure for it.â He said there is no medication for a person on bath salts so time is the best way to deal with it â waiting for the effects of the drug to wear off.
He noted they did find a drug test, but the samples must be mailed out for testing so it is not very useful.
Tucker said they treat users as having both mental illness and addictions.
âThey have psychiatric and substance abuse issues so we use a dual-pronged approach to treat them,â Tucker said. âThey are very dysfunctional. It is difficult to find the underlying functional disorder while they are still feeling the effects of the bath salts so we do the best we can and we do everything we can to help.â